James K. McCauley Insurance Agency

CONNECT

Address:

9220 Bonita Beach Road, Bldg B - Suite 105
Bonita Springs, FL 34135

Phone:

(239) 992-7888

Fax/Other:

(239) 405-8805

Health Insurance in 2017 & Beyond

We are proud to represent Blue Cross Blue Shield of Florida (Florida Blue). This is the top health insurance carrier in Florida, with the most health plans and the best rates.



They also have a number of large networks of quality service providers and facilities throughout the state of Florida as well as nationwide affiliate networks.

As of the Open Enrollment Season of 2017, Florida Blue became the ONLY insurance company offering individual and family health insurance in BOTH Collier & Lee counties.

  

Back in October of 2013 (before the first Obamacare Open Enrollment season) we became Certified Health Care Reform Specialists and every year before Open Enrollment starts we re-certify with the government and Florida Blue in order to provide this service to those who need it.



This on-going training enables us to screen applicants, inform them if they are eligible for the government tax credit which would lower their health insurance monthly premiums significantly.



We also assist clients to complete the government application (if applicable), help them to select a health plan that fits both their budget as well as their needs, make sure they understand their coverage and guide them in the selection of network providers and facilities so they use their health plans effectively.




The 2018 Open Enrollment Season will start November 1st of this year. 



The deadline to enroll in a new health plan or renew coverage with an effective date of January 1st will be December 15th. 




The deadline to enroll in a new health plan or renew coverage with an effective date of February 1st will be January 15th. 



The deadline to enroll in a new health plan or renew coverage with an effective date of March 1st will be January 31st. 




Since this program started we have been able to help THOUSANDS of NEW Clients who were NOT insured because their employer did not offer group insurance and they could not afford the high cost of individual insurance.  

Women and couples wanting to have a baby are now thrilled that these new health plans include maternity, delivery and newborn baby care with no waiting periods or exclusions, even if the insured is already pregnant when they enroll in the health plan.



We have also been able to help HUNDREDS of people that up to January 2014 were NOT INSURABLE due to serious illnesses such as diabetes, cancer, heart, etc. Now those individuals have quality and comprehensive health insurance coverage and NO EXCLUSIONS OF ANY PRE-EXISTING MEDICAL CONDITIONS.



Health Care Reform also does not allow insurance companies to "mark up" the rates due to a person's gender, weight or health.



So in spite of ALL the negative publicity which the new Health Care Reform and these new health plans are receiving in the media, there are two sides to every story and these new regulations are a BLESSING to many people of ALL ages and income levels who needed these changes. 



Last but NOT least, ALL health care plans now offer FREE preventive and wellness services as long as the insured uses ONLY network providers and facilities.  




What Types of Health Coverage Are Available?



There are three general classifications of quality major medical insurance plans: managed care (HMOs) PPOs, and high-deductible health plan (HDHP).


Managed Care



Managed-care plans became popular in the 1990s as a way to help reduce rising medical costs. In managed-care plans, insurance companies contract with a network of health-care providers to provide cost-effective health care. Managed-care plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.



Health Maintenance Organizations (HMOs)




An HMO is a network of physicians, hospitals, clinics, other health-care providers and facilities who contract with an insurance company to provide health care at reduced rates to individuals insured in the plan. Health care providers accept the HMO’s network fee schedule and guidelines. In addition to FREE preventive and wellness services, the insured usually has affordable co-payments for routine medical care.



The annual deductible and co-insurance only apply to catastrophic illnesses or injuries which require a visit to the emergency room, major diagnostic tests, hospitalization and / or a surgical procedure. 



Each covered member MUST select a "Primary-Care Physician" from doctors in the HMO Network of the plan. They must also ensure that ALL other providers they see (Specialists) and facilities they use are in the HMO network of their plan. HMOs DO NOT have Out-of-Network benefits. Consequently, the monthly premiums for these health plans are a lot less expensive than PPOs or POS plans.


Preferred Providers & Point of Service Organizations (PPOs & POS)



A PPO or POS is a network of physicians, hospitals, clinics, other health-care providers and facilities who contract with an insurance company to provide health care at reduced rates to individuals insured in the plan. Health care providers accept the PPO’s network fee schedule and guidelines. In addition to FREE preventive and wellness services, the insured usually has affordable co-payments for routine medical care. 



The annual deductible only applies to catastrophic illnesses or injuries which require a visit to the emergency room, major diagnostic tests, hospitalization and / or a surgical procedure.


Although PPOs and POS plans DO HAVE limited Out-of-Network benefits, and insured individuals can choose health care providers and facilities outside the network, this decision will increase their annual deductible, co-insurance, annual out-of-pocket costs and eliminate the affordable co-pays in their health plan. Also, the monthly premiums for PPO health plans are 30% to 40% higher than HMOs. 



High-Deductible (Health Savings Account Compatible) Plans (HSAs)



An HSA plan provides comprehensive coverage for high-cost medical bills and is usually combined with a health savings bank account that enables participants to build savings that will cover current and / or future medical expenses. 


Like ALL other POST Health Care Reform plan designs, HSA health plans also OFFER FREE preventive and wellness services. However, the IRS requires these plans to have higher annual deductibles, higher annual out-of-pocket expenses, higher co-insurance percentage and NO co-pays for routine medical care.



The insured enrolled in an HSA plan can open a health savings account at any local bank in order to build a medical emergency fund. There are calendar year annual limits on how much can be invested in an HSA account.



This money and any interest accumulate tax deferred. HSA funds can be withdrawn free of income tax and free of penalties provided the money is spent ONLY on qualified health-care expenses for the participant and his or her spouse and dependent children. Unused funds stay in the account and continue to grow. 




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